Ocsillometri

Aminah Dalimunthe

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 This study tracked the blood
pressure measurements of
12,031 healthy men in six
regions of the world for over
25 years. 1,291 of the
subjects died from coronary
heart disease (CHD).

For an increase of 10
mmHg in systolic blood
pressure, the relative risk
of death from CHD rose
by 28%. A 5 mmHg
increase in diastolic blood
pressure had a similar
effect.

These results closely match the outcomes

of other ten-year studies from different
regions of the world. They indicate the
importance of small increases in blood
pressure and the prerequisite of accurate
blood pressure measurement.

The New England Journal of Medicine, 2000

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 Hipertensi

suatu kondisi dimana terjadi peningkatan tekanan darah secara kronis

tekanan darah yang melebihi 140/90 mmHg saat istirahat.

 Tekanan Darah

Sistol

Diastol

Rerata Tekanan Arteri

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The ejection of blood from the left ventricle of the heart into the aorta produces
pulsatile blood pressure in arteries

Systolic blood pressure is the maximum pulsatile pressure

Diastolic pressure is the minimum pulsatile pressure in the arteries, the minimum
occurring just before the next ventricular contraction.

Normal systolic/diastolic values are 120/80 mmHg. Normal mean arterial pressure
is about 95 mmHg

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Mean arterial pressure (MAP) is defined as the average arterial pressure
during a single cardiac cycle.

The pulse pressure (PP) is defined as the difference between SP and DP

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non-invasive
blood
pressure
meter (NIBP).

BP

Invasive
blood
pressure
meter

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 Invasive blood pressure

uses a catheter inserted into the blood vessel to measure the BP continuously

general anaesthesia during operations.

very accurate and is accepted as the gold standard of arterial pressure

recording.

equipment and the procedure of invasive BP measurement require a

professional setup, calibration and operation
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 Auscultatory Method

.
Standard method of determining BP for over 100
years and relies on the observer to detect the
audible sounds (Korotkoff sounds) that occur
during constricted blood flow

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• Auscultatory method using a mercury column
or other sphygmomanometer, occluding cuff
and a stethoscope to listen to the sounds
made by the blood flow in the arteries, which
are called Korotkoff sounds
• This method is also called the Riva-Rocci /
Korotkoff method
• The observer determines the SP and DP values
by identifying the five phases of the Korotkoff
sound by using a stethoscope

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 Oscillometri Method

analyzes pulse waves collected from the cuff

during constricted blood flow.

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• The main difficultly of this method is to define
SP, MAP and DP from the oscillation pulse.
• This method uses an occluding cuff placed on
the brachial artery and inflated above SP.
• The sensor in the cuff will detect the pressure
oscillations of the arterial wall during the cuff
deflation
• The SP, MAP and DP would be defined from
the oscillation amplitudes.

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• Osiloskop terdiri dari dua bagian utama yaitu
display dan panel kontrol.
• Display menyerupai tampilan layar televisi
hanya saja tidak berwarna warni dan
berfungsi sebagai tempat sinyal uji
ditampilkan.
• Pada layar ini terdapat garis-garis melintang
secara vertikal dan horizontal yang
membentuk kotak-kotak dan disebut div.
• Arah horizontal mewakili sumbu waktu dan
garis vertikal mewakili sumbu tegangan.
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• Panel kontrol berisi tombol-tombol yang bisa
digunakan untuk menyesuaikan tampilan di
layar.
• osiloskop terdiri dari dua kanal yang bisa
digunakan untuk melihat dua sinyal yang
berlainan, contoh kanal satu untuk melihat
sinyal masukan dan kanal dua untuk melihat
sinyal keluaran.

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 Cara Operasi
1. Memastikan alat yang diukur dan osiloskop
ditanahkan(digroundkan). Tujuan untuk
keamanan dan mengurangi noise dari
frekuensi radio atau jala jala.
2. Memastikan probe dalam keadaan baik.
3. Kalibrasi tampilan bisa dilakukan dengan
panel kontrol yang ada di osiloskop.

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Tombol-tombol yang terdapat di panel osiloskop
antara lain :
Focus : Digunakan untuk mengatur fokus
Intensity : Untuk mengatur kecerahan garis yang
ditampilkan di layar
Trace rotation : Mengatur kemiringan garis
sumbu Y=0 di layar
Volt/div : Mengatur berapa nilai tegangan yang
diwakili oleh satu div di layar
Time/div : Mengatur berapa nilai waktu yang
diwakili oleh satu div di layar
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• Langkah awal pemakaian yaitu
pengkalibrasian. Yang pertama kali harus
muncul di layar adalah garis lurus mendatar
jika tidak ada sinyal masukan. Yang perlu
disetel adalah fokus, intensitas, kemiringan, x
position, dan y position. Dengan
menggunakan tegangan referensi yang
terdapat di osiloskop maka kita bisa
melakukan pengkalibrasian sederhana.

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• Ada dua tegangan referensi yang bisa dijadikan acuan yaitu
tegangan persegi 2 Vpp dan 0.2 Vpp dengan frekuensi 1 KHz.
Setelah probe dikalibrasi maka dengan menempelkan probe
pada terminal tegangan acuan maka akan muncul tegangan
persegi pada layar. Jika yang dijadikan acuan adalah tegangan
2 Vpp maka pada posisi 1 volt/div ( satu kotak vertikal
mewakili tegangan 1 volt) harus terdapat nilai tegangan dari
puncak ke puncak sebanyak dua kotak dan untuk time/div 1
ms/div ( satu kotak horizontal mewakili waktu 1 ms ) harus
terdapat satu gelombang untuk satu kotak. Jika masih belum
tepat maka perlu disetel dengan potensio yang terdapat di
tengah-tengah knob pengganti Volt/div dan time/div. Atau
kalau pada gambar osiloskop diatas berupa potensio dengan
label "var"

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 Position : Untuk mengatur posisi normal sumbu X
(ketika sinyal masukannya nol)
AC/DC : Mengatur fungsi kapasitor kopling di terminal
masukan osiloskop. Jika tombol pada posisi AC maka
pada terminal masukan diberi kapasitor kopling
sehingga hanya melewatkan komponen AC dari sinyal
masukan. Namun jika tombol diletakkan pada posisi
DC maka sinyal akan terukur dengan komponen DC-
nya dikutsertakan.
Ground : Digunakan untuk melihat letak posisi ground
di layar.
Channel 1/ 2 : Memilih saluran / kanal yang digunakan.

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 The oscillometric method has two
disadvantages:
• (1) artefact from the patient’s motion, as
these motions may appear very similar to a
real arterial pulse which may lead to the
changing of the oscillation pulse amplitudes;
• (2) irregular oscillation amplitudes which are
caused by a large number of the
cardiovascular diseases

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Auscultatory
Method

prone to poor technique,

observer digit bias and prone to errors when
poor hearing (often there is too much patient
unbeknownst to the arm movement
observer)

Oscillometri
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Choose the right equipment:
• 1. A quality stethoscope
2. An appropriately sized blood pressure cuff
3. A blood pressure measurement instrument such as an
aneroid or mercury column sphygmomanometer or an
automated device with a manual inflate mode.

Prepare the patient

• Make sure the patient is relaxed by allowing 5 minutes to relax
before the first reading. The patient should sit upright with
their upper arm positioned so it is level with their heart
and feet flat on the floor. Remove excess clothing that
might interfere with the BP cuff or constrict blood flow in the
arm. Be sure you and the patient refrain from talking during
the reading.
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Choose the proper BP cuff size
• Most measurement errors occur by not taking the
time to choose the proper cuff size. Wrap the cuff
around the patient's arm and use the INDEX line to
determine if the patient's arm circumference falls
within the RANGE area. Otherwise, choose the
appropriate smaller or larger cuff.

Place the BP cuff on the patient's arm

• Palpate/locate the brachial artery and position the BP
cuff so that the ARTERY marker points to the brachial
artery. Wrap the BP cuff snugly around the arm.
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Position the stethoscope
• On the same arm that you placed the BP cuff, palpate the
arm at the antecubical fossa (crease of the arm) to locate
the strongest pulse sounds and place the bell of the
stethoscope over the brachial artery at this location.
Inflate the BP cuff
• Begin pumping the cuff bulb as you listen to the pulse
sounds. When the BP cuff has inflated enough to stop
blood flow you should hear no sounds through the
stethoscope. The gauge should read 30 to 40
mmHg above the person's normal BP reading. If this value
is unknown you can inflate the cuff to 160 - 180 mmHg.
(If pulse sounds are heard right away, inflate to a higher
pressure.)
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Slowly Deflate the BP cuff
• Begin deflation. The AHA recommends that the
pressure should fall at 2 - 3 mmHg per second,
anything faster may likely result in an inaccurate
measurement.

Listen for the Systolic Reading

• The first occurence of rhythmic sounds heard as
blood begins to flow through the artery is the
patient's systolic pressure. This may resemble a
tapping noise at first.
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Listen for the Diastolic Reading
• Continue to listen as the BP cuff pressure drops and the
sounds fade. Note the gauge reading when the rhythmic
sounds stop. This will be the diastolic reading.

Double Check for Accuracy

• The AHA recommends taking a reading with both arms and
averaging the readings. To check the pressure again for
accuracy wait about five minutes between
readings. Typically, blood pressure is higher in the mornings
and lower in the evenings. If the blood pressure reading is a
concern or masked or white coat hypertension is suspected,
a 24 hour blood pressure study may be required to assess
the patient's overall blood pressure profile.
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